197411549-2-10-2023-12-CC-DMAX-CNWRS3-20230210121605

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197411549
Report Date: 02/09/2023
Date Signed: 02/10/2023 12:16:19 PM

Document Has Been Signed on 02/10/2023 12:16 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME:	HAMILTON FAMILY CHILD CARE		FACILITY NUMBER:	197411549
ADMINISTRATOR:	HAMILTON, NANCY ELLEN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(661) 799-5996
CITY:	VALENCIA	STATE: CA	ZIP CODE:	91355
CAPACITY:	14	CENSUS: 5	DATE:	02/09/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:50 PM
MET WITH:	Nancy Hamilton, Licensee		TIME COMPLETED:	04:00 PM

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25

Licensing Program Analyst (LPA) Maddox met with Nancy Hamilton, Licensee today for the purpose of conducting a unannounced Annual inspection. Present during this inspection were Licensee, and 5 day care children. This is a two story home with 3 bedroom, 4 bathroom home with kitchen/dining area, living room, and playroom, and garage. Licensee is the only adult in the home. Days/hours of operation are Mon through Friday from 6:30 am to 6:30 pm.

Physical Plant: Home is clean and orderly, fireplace is inaccessible, age appropriate toys and play equipment, working smoke detector and carbon monoxide detector, operable Fire Extinguisher (2A10BC), no one smokes in the home. Stairs are inaccessible via child safety gate. There are/are no weapon/firearms in the home. The facility sketch is complete and matches the home, off-limit areas are identified as the entire upstairs. Cleaning compounds inaccessible to children (locked in the kitchen). Medicines are inaccessible to children (located in a high cabinet in the Kitchen (there is a child safety gate to prevent children from entering the kitchen area).

Kitchen: The kitchen is toured and all hazardous items are inaccessible to children via child safety gate. Licensee provides Breakfast, Snack, Lunch, and Snack.

Bathroom: LPA observed a child safety latch on the cabinet. Toilets and faucets are clean, safe and operable. Bathtub and shower are free of hazards.

Outdoor: The yard is safe for children, there are no bodies of water on the premises. The outdoor play shall be supervised by the licensee or applicant.

SUPERVISOR'S NAME: Lady King	TELEPHONE: (310) 568-1824
LICENSING EVALUATOR NAME: Donna Maddox	TELEPHONE: (661) 568-8971
LICENSING EVALUATOR SIGNATURE:	DATE: 02/09/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 3

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: HAMILTON FAMILY CHILD CARE	FACILITY NUMBER: 197411549
	VISIT DATE: 02/09/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

There is a covered patio section for children to play (covered cabana). The area of the backyard used for child care is fenced (wood/wrought iron, brick) and gated. This play area is clear and clean of debris. There are age appropriate toys on the patio.

CPR/First Aid expire (7/2023). The electrical outlets are covered. Children nap on cots. There are 2 small dogs in the home. Windows are free from cracks, bugs and debris. There are no hanging window blinds cords accessible to children.

LPA discussed the safe sleep regulations with licensee [or facility representative] and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed Trenshonda Jackson of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

SUPERVISOR'S NAME: Lady King	TELEPHONE: (310) 568-1824
LICENSING EVALUATOR NAME: Donna Maddox	TELEPHONE: (661) 568-8971
LICENSING EVALUATOR SIGNATURE:	DATE: 02/09/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2023

LIC809 (FAS) - (06/04)

Page: 3 of 3

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: HAMILTON FAMILY CHILD CARE	FACILITY NUMBER: 197411549
	VISIT DATE: 02/09/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

The following was discussed with the Licensee:

Licensee was advised of the requirement to report Unusual Incidents. A report shall be made to the department by telephone or fax during the department's normal business hours before the close of the next working day following the occurrence during the operation of family day care home. In addition, a written report shall be submitted to the department within seven days following the occurrence of any events specified above. Licensee/Applicant was informed to utilize the Unusual Incident Report/Injury Report LIC624B when submitting the report to the department.

Licensee advised Licensee that the Notice of Site Visit must be posted at the entrance of the facility for a period of 30 days whenever a licensing inspection is conducted. If a Type A deficiency is cited, a copy of the licensing report must also be posted for 30 days. The same report must be provided to parents/guardians of children newly enrolled at the facility during the next 12 months & licensee must obtain a signed Acknowledgement of Licensing Reports (LIC 9224) from parent/guardian & place it in each child's file. Copies of the reports must be provided to each parent when a Type A violation is cited along with Acknowledgment of Receipt of Licensing Reports LIC 9224. If these requirements are not met civil penalties per violation will be assessed.

Exit interview conducted, copy of this report was read and provided to Licensee on this date. Due to time restraints, LPA will return to review files.

Licensee's email address: grneyegrl14@aol.com

SUPERVISOR'S NAME: Lady King	TELEPHONE: (310) 568-1824
LICENSING EVALUATOR NAME: Donna Maddox	TELEPHONE: (661) 568-8971
LICENSING EVALUATOR SIGNATURE:	DATE: 02/09/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2023

LIC809 (FAS) - (06/04)

Page: 2 of 3